PUBLISHER'S NOTE: It is important that the people should be able to obtain reliable information about medical matters over the Internet.
This is particularly true when it comes to information about shaken baby syndrome (SBS) - a controversial debunked 'hypothesis' - referred to in some courts as'junk science' which has led to the wrongful conviction of many innocent parents and caregivers in the U.S, and elsewhere, and currently has put Robert Roberson on death row in Texas.
So I decided to conduct an experiment aimed at discovering what people learn when they turn to three influential Internet sites for information about SBS: The Mayo Clinic, The Cleveland Clinic, and Johns Hopkins Children's hospital. (I have included the SBS sections from their respective public information sites - with links so you can see them with your own eyes, following my conclusions below. HL)
THE EXPERIMENT: Like anyone else seeking information I said the magic words 'Hey Siri' - and asked for information relating to each of the three institutions and "shaken baby syndrome."
THE RESULT: I was not surprised to discover that all three sites discussed the discredited syndrome in medical terms - namely that a 'triad' of unexplained bleeding one the brain, bleeding behind the retinas and brain swelling - indicates abuse.
However, I was very surprised to discover that not one of these influential sites went on to explain to the public that, as the Innocence Project has pointed out, developments in science and medicine require doctors to take a holistic look at a child's medical history "to rule out all of the many possible causes" for his or her medical condition and not rely only on "SBS.'
If, for example, Roberson's doctors would have conducted a 'holistic' approach, they would have discovered, as a court filing by his lawyers indicates, that Nikki died of of severe viral and bacterial pneumonia that progressed to sepsis and then sepsis shock and that, "There was no homicide."
Nor did the three institutions tell the public that, as the Innocence Project has pointed out, shaken Baby Syndrome is a a condition that was never scientifically validated, and that its premises have been discredited by actual science.
CONCLUSION: I am not suggesting any of the three institutions have been motivated by malice in providing such limited information to the public. To the contrary, it must be extremely difficult to keep the public up to date with the vast world of medical knowledge. By and large they do a fantastic job. I, and members of my family, visit their sites regularly when I need medical information, (sometimes at 3.00 AM!).
But when it comes to shaken baby syndrome - the public has to be fully informed, as to do otherwise can lead to innocent parents and caregivers being convicted and punished for crimes that ever occurred - and can lead to awful consequences such as having other children seized by by child protection authorities and put up for adoption, and being branded as pariah's in their communities - their lives destroyed.
This is not hypothetical, dear reader.
The National Registry of Exonerations reports that to date, at least 34 people convicted based on shaken baby syndrome diagnosis have been exonerated. (The Registry defines a exoneree as having been convicted of injuring or killing an infant by violent shaking based on a medical diagnosis that is now highly controversial.)
My recommendations are simple:
The Mayo Clinic, Cleveland Clinic and John Hopkins Hospital should revamp their shaken baby syndrome sites with up-to-date information on developments in science and the law, as suggested along the lines of this post.
Moreover, if not the case, the three institutions should make it clear by written policy that their physicians and staff are expected to conduct full, open-minded investigations when confronted with situations involving death of children who have been under the care of children and caregivers - and must consider all factors that might be relevant, not just SBS,
That can't happen soon enough.
Harold Levy: Publisher: The Charles Smith Blog.
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THE MAYO CLINIC; By Mayo Clinic Staff: March 18, 2023;
Overview
Shaken baby syndrome is a serious brain injury resulting from forcefully shaking an infant or toddler. It's also known as abusive head trauma, shaken impact syndrome, inflicted head injury or whiplash shaken infant syndrome.
Shaken baby syndrome destroys a child's brain cells and prevents his or her brain from getting enough oxygen. This form of child abuse can cause permanent brain damage or death.
Shaken baby syndrome is preventable. Help is available for parents who are at risk of harming a child. Parents also can educate other caregivers about the dangers of shaken baby syndrome.
Symptoms
Shaken baby syndrome symptoms and signs include:
- Extreme fussiness or irritability
- Difficulty staying awake
- Breathing problems
- Poor eating
- Vomiting
- Pale or bluish skin
- Seizures
- Paralysis
- Coma
While sometimes there's bruising on the face, you may not see signs of physical injury to the child's outer body. Injuries that might not be immediately seen include bleeding in the brain and eyes, spinal cord damage, and fractures of the ribs, skull, legs and other bones. Many children with shaken baby syndrome show signs and symptoms of prior child abuse.
In mild cases of shaken baby syndrome, a child may appear normal after being shaken, but over time they may develop health or behavioral problems.
When to see a doctor
Seek immediate help if you suspect your child has been injured by violent shaking. Call 911 or emergency medical help, or take your child to the nearest emergency room. Getting medical care right away may save your child's life or prevent serious health problems.
Health care professionals are legally required to report all suspected cases of child abuse to state authorities.
Babies have weak neck muscles and can't support the weight of their heads. If a baby is forcefully shaken, their fragile brain moves back and forth inside the skull. This causes bruising, swelling and bleeding.
Shaken baby syndrome usually occurs when a parent or caregiver severely shakes a baby or toddler due to frustration or anger — often because the child won't stop crying.
Shaken baby syndrome isn't usually caused by bouncing a child on your knee or minor falls.
CAUSES
Babies have weak neck muscles and can't support the weight of their heads. If a baby is forcefully shaken, their fragile brain moves back and forth inside the skull. This causes bruising, swelling and bleeding.
Shaken baby syndrome usually occurs when a parent or caregiver severely shakes a baby or toddler due to frustration or anger — often because the child won't stop crying.
Shaken baby syndrome isn't usually caused by bouncing a child on your knee or minor falls.
Risk factors
The following things may increase the risk that parents or caregivers are more likely to forcefully shake a baby and cause shaken baby syndrome:
- Unrealistic expectations of babies
- Young or single parenthood
- Stress
- Domestic violence
- Alcohol or substance abuse
- Unstable family situations
- Depression
- A history of mistreatment as a child
Also, men are more likely to cause shaken baby syndrome than are women.
Complications
Even brief shaking of an infant can cause irreversible brain damage. Many children affected by shaken baby syndrome die.
Survivors of shaken baby syndrome may require lifelong medical care for conditions such as:
- Partial or total blindness
- Developmental delays, learning problems or behavior issues
- Intellectual disability
- Seizure disorders
- Cerebral palsy, a disorder that affects movement and muscle coordination
Prevention
New parent education classes can help parents better understand the dangers of violent shaking and may provide tips to soothe a crying baby and manage stress.
When your crying baby can't be calmed, you may be tempted to try anything to get the tears to stop — but it's important to always treat your child gently. Nothing justifies shaking a child.
If you're having trouble managing your emotions or the stress of parenthood, seek help. Your child's doctor may offer a referral to a counselor or other mental health provider.
If other people help take care of your child — whether a hired caregiver, sibling or grandparent — make sure they know the dangers of shaken baby syndrome.
Diagnosis
A child who's been forcefully shaken will need to be examined by many different medical specialists, as well as an expert in child abuse.
The doctor will examine the child and ask questions about the child's medical history. Various tests may be needed to detect injuries, including:
- Skeletal survey. Several X-rays of the bones — possibly including the arms, hands, legs, feet, spine, ribs and skull — may be used to determine whether fractures are accidental or purposeful. Such testing can also help find previous fractures.
- Eye exam. An eye exam can reveal bleeding in the eye and other eye injuries.
- Blood tests. Some metabolic and genetic disorders, as well as bleeding and clotting disorders, can cause symptoms similar to shaken baby syndrome. Blood tests can help rule out some of these conditions.
- Magnetic resonance imaging (MRI). MRI uses a powerful magnetic field and radio waves to create detailed images of a child's brain and spine. It can show brain bruising, bleeding and signs of decreased oxygen. Because an MRI is difficult to perform on a child who's unstable, it's usually done two to three days after the injury.
- Computerized tomography (CT) scan. A CT scan uses X-ray images to provide cross-sectional images of the body. A CT scan of the brain can help detect injuries that need urgent treatment. A CT scan of the abdomen may also be done to determine if there are additional injuries.
Depending on the extent of the injuries, the baby may need to be monitored in a pediatric intensive care unit.
Treatment
Emergency treatment for a child who has been shaken may include breathing support and surgery to stop bleeding in the brain. Some children may require medications to reduce brain swelling and prevent seizures.
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THE CLEVELAND CLINIC: Shaken Baby Syndrome: Medically reviewed: (Last reviewed on 08/11/ 2022;
"Shaken baby syndrome is a type of severe child abuse that occurs when a caregiver violently shakes a child. The condition can cause swelling, bruising and bleeding in a baby’s brain, and it can lead to brain damage, lifelong disabilities and even death. It most often occurs when a caregiver becomes frustrated. Overview
Overview: What is shaken baby syndrome?
Shaken baby syndrome is a type of brain injury that occurs when a baby or toddler is shaken violently. This can cause swelling, bruising and bleeding in and around their brain. Shaken baby syndrome may damage a child’s eyes, neck and spine as well. Another name for the condition is abusive head trauma.
Infants’ heads are very large and heavy in proportion to the rest of their bodies. When a child is shaken, their brain bounces back and forth against the sides of their skull. Shaking can cause bleeding in their brain or behind their eyes.
Shaken baby syndrome most often happens when a parent or other caregiver becomes frustrated or angry because of a baby’s crying. It can occur from as little as 5 seconds of shaking. The resulting injuries can lead to brain damage, permanent disabilities and death.
Why does shaken baby syndrome happen?
Parents or caregivers may shake a baby because it’s been crying for a long time. They may think that shaking the baby will make them stop crying. Some parents or caregivers may be under stress for various reasons. They may become frustrated and unable to cope with the responsibilities of caring for a child. Other caregivers may simply not know that shaking a baby can be so dangerous.
Crying is a normal behavior in babies. Your infant may cry inconsolably at times. Shaking, hitting or throwing a baby is never OK.
Who does shaken baby syndrome affect?
Shaken baby syndrome can affect anyone. People who are most likely to shake a baby have a direct connection to the baby (a parent) or an indirect connection (babysitter, secondary family members). Shaken baby syndrome can happen among families of any ethnicity, any income range and with any type of family composition.
Shaken baby syndrome most often affects babies younger than 1 year old. Infants between the ages of 2 and 8 months are most at risk. The condition doesn’t typically occur in children over the age of 2, but children as old as 6 have been victims of this kind of abuse.
How common is shaken baby syndrome?
According to the National Center on Shaken Baby Syndrome, they are between 600 and 1,400 cases of shaken baby syndrome in the U.S. each year. This condition is the most common cause of child abuse death in children younger than 5 years old in the U.S. Shaking a baby can cause severe bleeding in their brain.
How does shaken baby syndrome affect my baby?
Shaken baby syndrome can cause severe medical issues, including:
- Subdural hematoma: A collection of blood between the surface of your child’s brain and their dura (the tough outer membrane surrounding their brain). This can happen when the veins that bridge your child’s brain to their dura are stretched too far, causing tears and bleeding.
- Subarachnoid hemorrhage: Bleeding between your child’s brain and arachnoid (the web-like membrane surrounding your child’s brain).
- Direct brain trauma: This can occur when your child’s brain strikes the inner surfaces of their skull.
- Brain damage: Brain damage can result from a lack of oxygen if your child stops breathing during shaking.
- Brain cell damage: This can occur when injured nerve cells release chemicals that add to the oxygen deprivation to your child’s brain.
- Retinal hemorrhages: Bleeding in the back of your child’s retinas.
- Neck and spinal cord damage: Injuries to your child’s cervical spinal nerves.
- Fractures: This may include skull fractures as well as fractures to your baby’s ribs, collarbone, arms and legs.
Symptoms and Causes
How soon do symptoms of shaken baby syndrome appear?
Signs of shaken baby syndrome may appear immediately after the child has been shaken. The signs typically reach their peak within four to six hours. Some symptoms show up right away, but shaken baby syndrome symptoms may not appear until later in life. Some children may have attention and behavior problems later in life from being shaken when they were infants.
What are the symptoms of shaken baby syndrome?
What are the symptoms of shaken baby syndrome?
A child or baby who’s been shaken may have an injury to their brain. Severe immediate signs of shaken baby syndrome may include unconsciousness, seizures and shock. Other shaken baby syndrome symptoms may include:
- Not smiling, babbling or talking.
- Extreme irritability.
- Vomiting.
- Poor appetite or feeding problems.
- Breathing difficulties.
- Lethargy (extreme tiredness, lack of movement and/or an inability to stay awake).
- Pale- or blue-colored skin.
- Bruises on their arms or chest.
- A large head or forehead.
- A bulging soft spot on the top of their head.
- Inability to lift their head.
- Widened (dilated) pupils.
- Inability to focus or follow movement with their eyes.
- Tremors.
- Coma.
Can shaken baby syndrome go unnoticed?
Sometimes there are no obvious external signs of physical violence or injury. Caregivers and healthcare providers who aren’t aware a baby’s been shaken may not immediately find internal injuries. They may attribute a baby’s symptoms to another cause, such as a virus.
What causes shaken baby syndrome?
When someone shakes a baby or young child violently, shaken baby syndrome can occur. Hitting the child on the head, throwing them and dropping them on purpose can also cause the condition. Shaking or hitting a child can cause their brain to shake back and forth inside their skull.
Children's brains are softer and their ligaments are weaker. Their neck muscles aren’t fully developed yet. In addition, their heads are large and heavy in proportion to the rest of their bodies. The violent shaking tears the child’s blood vessels, nerves and tissues, causing their brain to swell, bruise and bleed.
Shaken baby syndrome most often happens at the hands of an overwhelmed and frustrated caregiver who can’t cope with a baby’s inconsolable crying. The caregiver gets angry or stressed and loses control. Most times, the caregiver didn’t mean to harm the baby, but it’s still a form of child abuse.
Can bouncing a baby cause shaken baby syndrome?
Shaken baby syndrome is a type of child abuse. It happens when someone violently shakes a baby or small child. It’s not caused by:
- Bouncing your baby on your knee.
- Tossing your baby in the air.
- Bicycling with your baby.
- Accidental falls off furniture.
- Sudden stops or going over bumps while driving.
These activities can be dangerous and therefore aren’t recommended, but they won’t cause the kinds of injuries seen in shaken baby syndrome.
Diagnosis and Tests
How is shaken baby syndrome diagnosed?
Diagnosing shaken baby syndrome may be difficult for several reasons:
- Healthcare providers don’t always get the truth about whether or not shaking was involved in an infant’s injury.
- Babies and very small children can’t tell healthcare providers what happened or what hurts.
- Many symptoms of shaken baby syndrome (such as irritability, vomiting or lethargy) are also common in other conditions, such as viral infections.
Therefore, a healthcare provider will use visual clues and tests to diagnose the condition and determine how severe it is. They’ll check your baby’s eyes for bleeding, look for marks on their skull, arms or legs, and check for bruises around their neck and chest.
What tests will be done to diagnose shaken baby syndrome?
Healthcare providers may use certain imaging tests to diagnose shaken baby syndrome. These tests can show signs of swelling or bleeding in your baby’s brain and also show skull or rib fractures. These tests may include:
Your baby’s provider may also perform an eye examination to look for evidence of retinal bleeding (bleeding at the back of their eyes). The bleeding may be above, within or below their retinas. The layers of your baby’s retinas may also be split apart as a result of injury (retinoschisis). The jelly-like filling inside their eyes (vitreous) may also fill with blood.
Management and Treatment
How is shaken baby syndrome treated?
If your baby has any signs of shaken baby syndrome, they need immediate medical treatment. For milder cases, your baby may need medicine and observation at the hospital.
In more severe cases, treatment may include life-saving measures. A healthcare provider may insert a breathing tube down your child’s throat to provide respiratory support. A surgeon may have to perform surgery to stop bleeding or reduce swelling in your baby’s brain.
PREVENTION
How can shaken baby syndrome be prevented?
Parents or caregivers who shake babies usually say that the shaking occurred when their baby was crying inconsolably. It’s normal for babies to cry, and it can get stressful. Understanding the dangers of shaking your baby and finding support can help prevent shaken baby syndrome. Some things you can do to avoid shaken baby syndrome include:
- First, make sure that nothing obvious is wrong with your baby. You should check to see that their diaper is clean and ensure your baby isn’t hungry or cold. Make sure there’s no sign of illness, such as fever or swelling, and that nothing is causing pain.
- If your baby's needs are met, try using noise. You can put on a radio, or sing and talk to your baby. Sometimes, babies like noises like vacuum cleaners, clothes dryers, hair dryers or fans.
- Offer your baby a toy or pacifier.
- Try breastfeeding, or offer a bottle to your baby.
- Swaddle your baby, or try rocking them.
- Take your baby for a ride in the car (appropriately secured in their car seat).
- Place your baby in a stroller, and go for a walk.
- Take your baby for a ride on an outdoor swing.
- Ask someone else (a friend, a co-worker, a neighbor or a family member) to take over for you for a period of time so you can have a break. It’s very reasonable to ask for help.
- If no one else is available to take over for you, put your baby safely in their crib and leave the room for a few minutes while you calm down. Remember, crying won’t hurt babies, but shaking will.
Make sure all of your babysitters, nannies and other caregivers know about the dangers of shaking a baby. Ensure they know what to do — and what not to do — if they feel stressed while caring for your child. Always check references and choose your caregivers carefully. Never leave your baby with a caregiver whom you don’t trust completely.
Outlook / Prognosis
What is the outlook (prognosis) for shaken baby syndrome?
Shaken baby syndrome is a very serious condition. The prognosis varies by the severity of your baby’s injuries but is generally poor. About 25% of babies will die due to their injuries. Death is typically caused by:
- Swelling and pressure within your baby’s skull and brain.
- Bleeding within your baby’s brain.
- Tears in your baby’s brain tissue.
Up to 80% of those that survive will experience serious medical problems, severe neurological deficits and lifelong disabilities. Even babies that appear to have only mild shaken baby syndrome injuries may show signs of developmental difficulties. Shaken baby syndrome may cause disabilities including:
- Speech and developmental delays.
- Learning disabilities.
- Vision loss or blindness.
- Permanent hearing loss.
- Cerebral palsy.
- Epilepsy.
- Seizures.
- Paralysis.
A note from Cleveland Clinic
Shaken baby syndrome is a form of severe physical child abuse that occurs when a parent or caregiver violently shakes a baby or child. The condition most often occurs when a caregiver becomes angry or frustrated when a baby won’t stop crying. Shaken baby syndrome is completely preventable. If your baby won’t stop crying, try some of the tips in the Prevention section above, or ask a trusted caregiver for help."
https://my.clevelandclinic.org/health/diseases/13779-shaken-baby-syndrome
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JOHN'S HOPKINS AND SHAKEN BABY SYNDROME:
What is shaken baby syndrome?
Shaken baby syndrome is a type of inflicted traumatic brain injury that happens when a baby is violently shaken. A baby has weak neck muscles and a large, heavy head. Shaking makes the fragile brain bounce back and forth inside the skull and causes bruising, swelling and bleeding, which can lead to permanent, severe brain damage or death. Shaken baby injuries usually occur in children younger than two years old but may be seen in children up to the age of five.
Symptoms
The characteristic injuries of shaken baby syndrome are subdural hemorrhages (bleeding in the brain), retinal hemorrhages (bleeding inside the eye), damage to the spinal cord and neck and fractures of the ribs and bones. These injuries may not be immediately noticeable. Symptoms of shaken baby syndrome include:
- Breathing problems
- Convulsions
- Extreme irritability
- Lethargy
- Poor feeding
- Vomiting and pale or bluish skin
Treatment
Emergency treatment for a baby who has been shaken usually includes life-sustaining measures, such as respiratory support and surgery, to stop internal bleeding and bleeding in the brain. Doctors may use brain scans, including MRI and CT scans, to make a more definite diagnosis.
Prognosis
In comparison with accidental traumatic brain injury in infants, shaken baby injuries have a much worse prognosis. Damage to the retina of the eye can cause blindness. The majority of infants who survive severe shaking will have some form of neurological or mental disability, such as cerebral palsy or mental retardation, which may not be fully apparent before six years of age. Children with shaken baby syndrome may require lifelong medical care.
PUBLISHER'S NOTE: I am monitoring this case/issue/resource. Keep your eye on the Charles Smith Blog for reports on developments. The Toronto Star, my previous employer for more than twenty incredible years, has put considerable effort into exposing the harm caused by Dr. Charles Smith and his protectors - and into pushing for reform of Ontario's forensic pediatric pathology system. The Star has a "topic" section which focuses on recent stories related to Dr. Charles Smith. It can be found at: http://www.thestar.com/topic/charlessmith. Information on "The Charles Smith Blog Award"- and its nomination process - can be found at: http://smithforensic.blogspot.com/2011/05/charles-smith-blog-award-nominations.html Please send any comments or information on other cases and issues of interest to the readers of this blog to: hlevy15@gmail.com. Harold Levy: Publisher: The Charles Smith Blog.
- SEE BREAKDOWN OF SOME OF THE ON-GOING INTERNATIONAL CASES (OUTSIDE OF THE CONTINENTAL USA) THAT I AM FOLLOWING ON THIS BLOG, AT THE LINK BELOW: HL:
https://www.blogger.com/blog/post/edit/120008354894645705/4704913685758792985
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FINAL WORD: (Applicable to all of our wrongful conviction cases): "Whenever there is a wrongful conviction, it exposes errors in our criminal legal system, and we hope that this case — and lessons from it — can prevent future injustices."
Lawyer Radha Natarajan:
Executive Director: New England Innocence Project;
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FINAL, FINAL WORD: "Since its inception, the Innocence Project has pushed the criminal legal system to confront and correct the laws and policies that cause and contribute to wrongful convictions. They never shied away from the hard cases — the ones involving eyewitness identifications, confessions, and bite marks. Instead, in the course of presenting scientific evidence of innocence, they've exposed the unreliability of evidence that was, for centuries, deemed untouchable." So true!
Christina Swarns: Executive Director: The Innocence Project;
